ptsd Appealling And Trying To Understand Denial Wording. Thanks.

[cowgirl]

Working on my appeal and I am having difficulty understanding the "of rule out" portion of the statement I recieved on my denial; Help anyone? Maybe the word "of" has got my goat, I dont speak legalize often.

"records show provisional diagnosis of rule out PTSD on the basis of your subjective reports of traumatic experience upon PTSD screen" Anyone have a clue? Thanks,CG

[Stretch]

Timetowinarace is correct. Rule out means that the condition is a possibility. The VA is not supposed to use rule out because of its missunderstanding.

The Warms Clinical guide specifically states not to use rule out as a diagnosis. Read it for yourself so that you will know.

http://www.warms.vba.va.gov/admin21/guide/...iciansguide.doc

[cowgirl]

Great, Okay got it; saved it to a file, sure defines alot, I thought "possibility" also. Hope to limit my TMJ as I go through the appeal processes. Receiving and sharing lessons learned at Hadit is just awesome! cg

Timetowinarace is correct. Rule out means that the condition is a possibility. The VA is not supposed to use rule out because of its missunderstanding.

The Warms Clinical guide specifically states not to use rule out as a diagnosis. Read it for yourself so that you will know.

http://www.warms.vba.va.gov/admin21/guide/...iciansguide.doc

[Hoppy]

Cowgirl,

Pinning down a diagnosis on a psych claim can be a little more difficult than most claims. I am not sure that you need to file a separate claim for each diagnosis. I would consider telling the RO that you are either amending the original PTSD claim to include depression in relational to PTSD or any other psych condition. After all depression is a symptom of several different psych conditions.

There is a rule that a claim must include a diagnosis. I would argue that depression is inherent in PTSD and thus any psych claim involving depression would be suggested by any Psych claim that involves key features of depression.

I actually filed a claim for PTSD and later amended it to include. PTSD due to life threatening aggravated assault that occurred while on active duty. PTSD secondary to numerous life threatening severe episodes of service connected angioedema, schizoaffective disorder, depression, anxiety disorder secondary to service connected angioedema, a separate anxiety disorder that preceded the onset of severe symptoms of angioedema with symptoms of anxiety disorder dating back to service and lastly but not least non pathological adjustment disorder secondary to life threatening service connected angioedema, as defined in the DSM IV TR.

Why did I file such. Because I had seen psychiatrists three times while on active duty and on a sufficiently continuous basis subsequent to service (30 years) to suggest a life time condition. Additional, over thirty years I had reports with all of the above diagnoses made by different shrinks at different times. There are psychiatric conditions that evolve over decades and it takes decades to make the diagnosis. I have read decisions where veterans were service connected in their 30’s for diagnoses made when they were thirty with early symptoms of the conditions noted in the SMR 20 years prior to the diagnosis made in the thirties.

When the DRO saw all of these diagnoses and reports he told me the resolution was out of his league and his only recourse was to get an opinion from the a psychiatrist of his choice. The bottom line is that if someone has a life threatening disease that puts them in an ER on 20+ occasions over decades for life saving medical intervention, such individual will make adaptive changes to stay alive. Such adaptive changes resulted in a GAF of 40. The shrinks can call it what they want.

As for your claim, changing diagnoses over time could be par for the course. The problem with service connection as I understand it is that a PTSD claim can be service connected with post service symptoms only. All other psych conditions need to show some symptoms while on active duty or immediately after discharge. The exact timing for the onset of symptoms could be very important. When I was reading BVA claims the BVA routinely denied psych claims when there were no notes in the SMR describing symptomology. There exact wording is something to the effect that “the SMR was silent for symptoms of a psychological condition”. When I was reading BVA claims 7 years ago many claims were filed for general terms such as " non specific psycholigical condition". I did not see any denials at that time suggesting that the diagnostic terminology was to vague. This might have changed. However, calling it a psych condition is a type of diagnosis. I am sure that the RO is aware that psych diagnoses can evolve over decades.

The important thing is to keep you and your family involved in the treatment of the condition. Tell your SO to keep an open mind as to any diagnosis that involves depression as inclusive of a claim for PTSD and or any other psych condition with symptoms of depression. There are other indicators of depression to look for in your records. Any reference in your SMR that show “somatization” can be equated key features of a major depressive episode as defined in the DSM IV TR. Most shrink do not even know this.

My thoughts

[Guest elizabeth]

Working on my appeal and I am having difficulty understanding the "of rule out" portion of the statement I recieved on my denial; Help anyone? Maybe the word "of" has got my goat, I dont speak legalize often.

"records show provisional diagnosis of rule out PTSD on the basis of your subjective reports of traumatic experience upon PTSD screen" Anyone have a clue? Thanks,CG

[/quotego to your web page -section 38 rule -of rule out that how you;ll find youa answer then check duty to assist-benift of doubt then file a appeal every vetersn should have local ro fax number always send in by fax you;ll get it there the same day plus have proof of va receving date of fax Elizabeth